Insomnia what to do

Insomnia

In this Article

What Is Insomnia?

Insomnia is a sleep disorder in which you have trouble falling and/or staying asleep.

The condition can be short-term (acute) or can last a long time (chronic). It may also come and go.

Acute insomnia lasts from 1 night to a few weeks. Insomnia is chronic when it happens at least 3 nights a week for 3 months or more.

Types of Insomnia

There are two types of insomnia: primary and secondary.

You might also hear about:

Insomnia Causes

Primary causes ofВ insomniaВ include:

Secondary causes ofВ insomniaВ include:

Insomnia Risk Factors

Insomnia affects women more than men and older people more than younger ones. Young and middle-age African Americans also have a higher risk.

Other risk factors include:

Insomnia Symptoms

Symptoms of insomnia include:

Insomnia Diagnosis

Your doctor will do a physical exam and ask about your medical history and sleep history.

They might tell you to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. They may talk to your bed partner about how much and how well you’re sleeping. You might also have special tests at a sleep center.

Insomnia Treatment

Acute insomnia may not need treatment.

If it’s hard for you to do everyday activities because you’re tired, your doctor may prescribe sleeping pills for a short time. Medicines that work quickly but briefly can help you avoid problems like drowsiness the next day.

Don’t use over-the-counter sleeping pills for insomnia. They might have side effects, and they tend to work less well over time.

For chronic insomnia, you’ll need treatment for the conditions or health problems that are keeping you awake. Your doctor might also suggest behavioral therapy. This can help you change the things you do that make insomnia worse and learn what you can do to promote sleep.

Insomnia Complications

Our bodies and brains need sleep so they can repair themselves. It’s also crucial for learning and keeping memories. If insomnia is keeping you awake, you could have:

Insomnia Prevention

Good sleep habits, also called sleep hygiene, can help you beat insomnia. Here are some tips:

Show Sources

American Insomnia Association.

National Heart, Lung, and Blood Institute: “Insomnia.”

National Sleep Foundation: “Insomnia.”

Journal of Clinical Sleep Medicine: “Insomnia: Definition, Prevalence, Etiology, and Consequences.”

Office on Women’s Health: “Insomnia.”

Mayo Clinic: “Insomnia.”

Harvard Health Publishing: «Too early to get up, too late to get back to sleep.»

Sleep Foundation: «Types of Insomnia,» «ADHD and Sleep,» «PMS and Insomnia.»

American Family Physician: «Paradoxical Insomnia: Misperception of Sleep Can Be a Tormenting Experience.»

Nature Genetics: «Biological and clinical insights from genetics of insomnia symptoms.»

American Pregnancy Association: «Pregnancy Insomnia: Snooze or Lose.»

Neurology Clinical Practice: «Approach to insomnia in patients with dementia.»

Sleep Foundation: «PMS and Insomnia,» «ADHD and Sleep.»

Minnesota Medicine: «Substance abuse and insomnia.»

Insomnia Symptoms, Causes, and Treatments

Lindsay Cook, PharmD is a board-certified consultant pharmacist.

Overview

If you have difficulty falling or staying asleep, or your sleep is not refreshing, you may be suffering from insomnia. The condition also includes sleep that is of poor quality resulting in excessive daytime sleepiness. It is the most common sleep disorder, affecting nearly everyone at some point in our lives. There may be identifiable factors that interfere with sleep, such as poor sleep environment, pain, stress, or getting up to urinate (nocturia). Insomnia may be episodic, for instance, only occurring during periods of stress, but if it persists chronically at least three nights per week for at least three months, it may require treatment.

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Frederic Cirou / PhotoAlto Agency / Getty Images

Types

There are two types of insomnia: acute (short-term) or chronic (ongoing). Other sleep disorders may have insomnia as a component, including:

No matter the type of insomnia that you may be experiencing, you can discover solutions and effective treatments.

Prevalence

Insomnia is one of the most common medical complaints. It is estimated that approximately 20% of US adults experience insomnia. 

Women tend to report more insomnia complaints.   Insomnia becomes more common as we get older. Individuals who are unemployed, live alone, and are of lower socioeconomic status also have more complaints of insomnia.

Symptoms

Insomnia is characterized by difficulty falling or staying asleep or by sleep that is of poor quality.   It may be associated with early morning awakenings. There are, however, other symptoms that may be associated with insomnia. These symptoms include:

It is no surprise that if we don’t sleep well, we don’t feel well while awake.

Causes

Most acute insomnia is brought on by stress, while most cases of chronic insomnia are secondary, or a symptom or side effect of some other problem. Insomnia may occur in the context of other sleep disorders (most commonly sleep apnea and restless legs syndrome), general medical conditions (especially those that cause pain), or illnesses. The triggers may be temporary or persistent.

Insomnia may be the result of stress. The loss of a job with financial problems, the death of a loved one, or a divorce may trigger stress that in turn causes insomnia. It may be associated with other psychiatric problems, such as anxiety or depression, post-traumatic stress disorder (PTSD), or even neurological disorders like dementia.

Insomnia may result from the use of certain prescription or over-the-counter medications or street drugs. It can also occur during withdrawal from certain substances. Insomnia may arise due to shift work or travel (such as with jet lag). It may temporarily occur if caffeine or cigarettes are used too close to bedtime or as the result of other poor sleep habits. People with insomnia often spend too much time in bed while awake. By limiting time spent in bed, a consistent sleep schedule can be reestablished.

While it’s unlikely that insomnia will occur because of a vitamin deficiency, it frequently happens when the sleep environment is disrupted, such as when pets, television or other devices are present.

Insomnia may have no recognized cause.

Diagnosis

Most individuals with insomnia can be diagnosed after a brief discussion with their doctor. However, there are multiple tests available to diagnose insomnia if they are needed. Some of these include:

Additional testing is often needed if another disorder is suspected, such as sleep apnea, narcolepsy, or circadian rhythm disorders.

Treatment

Medication

If insomnia results in disrupted daytime function, especially if it persists chronically, it may require treatment. There are many effective medications that can be helpful for short-term use. Two major classes include benzodiazepine and nonbenzodiazepine medications. Some of these prescription and over-the-counter medications include:

Non-Medication

There are also alternatives to treatment with medications, including making changes in behaviors or sleep habits. Some of the more common alternative therapies for insomnia include:

A Word From Verywell

Insomnia is the most common sleep complaint, affecting nearly everyone at some point in our lives. It can exist in multiple subtypes or even as part of other sleep disorders or medical conditions. There may be associated symptoms such as difficulties with memory, concentration, and mood. Insomnia may be caused by many things, and a careful evaluation by a doctor is usually sufficient to establish a diagnosis.

Occasionally further tests may be indicated. Fortunately, there are effective treatments for insomnia, including many prescription and over-the-counter sleeping pills as well as alternative therapies, such as improving sleep habits or the sleep environment.

If it persists, cognitive behavioral therapy for insomnia (CBTI) may be the most effective treatment option. Our Doctor Discussion Guide below can help you start that conversation with a doctor to find the best treatment option.

Insomnia Doctor Discussion Guide

Get our printable guide for your next doctor’s appointment to help you ask the right questions.

Insomnia: Symptoms, Causes, and Treatment

Can’t sleep? If you struggle to fall asleep or stay asleep at night, it can take a huge toll on your health. Here’s how to beat insomnia and end the sleepless nights.

What is insomnia?

Insomnia is the inability to fall asleep or stay asleep at night, resulting in unrefreshing or non-restorative sleep. And it’s a very common problem, one that takes a toll on your energy, mood, and ability to function during the day. Chronic insomnia can even contribute to serious health problems.

Some people struggle to get to sleep no matter how tired they are. Others wake up in the middle of the night and lie awake for hours, anxiously watching the clock. But, because different people need different amounts of sleep, insomnia is defined by the quality of your sleep and how you feel after sleeping—not the number of hours you sleep or how quickly you doze off. Even if you’re spending eight hours a night in bed, if you feel drowsy and fatigued during the day, you may be experiencing insomnia.

Although insomnia is the most common sleep complaint, it is not a single sleep disorder. It’s more accurate to think of it as a symptom of another problem, whether it’s something as simple as drinking too much caffeine during the day or something more complex like feeling overloaded with stress.

The good news is that most cases of insomnia can be cured with changes you can make on your own—without relying on sleep specialists or turning to prescription or over-the-counter sleeping pills. By addressing the underlying causes and making simple changes to your daily habits and sleep environment, you can put a stop to the frustration of insomnia and finally get a good night’s sleep.

If you’re having trouble sleeping right now …

Symptoms of insomnia include:

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Causes of insomnia: Figuring out why you can’t sleep

In order to properly treat and cure your insomnia, you need to become a sleep detective. Emotional issues such as stress, anxiety, and depression cause half of all insomnia cases. But your daytime habits, sleep routine, and physical health may also play a role. Try to identify all possible causes of your insomnia. Once you figure out the root cause, you can tailor treatment accordingly.

What’s causing your insomnia?

Common psychological and medical causes of insomnia

Sometimes, insomnia only lasts a few days and goes away on its own, especially when it is tied to an obviously temporary cause, such as stress over an upcoming presentation, a painful breakup, or jet lag. Other times, insomnia is stubbornly persistent. Chronic insomnia is usually tied to an underlying mental or physical issue.

Anxiety, stress, and depression are some of the most common causes of chronic insomnia. Having difficulty sleeping can also make anxiety, stress, and depression symptoms worse. Other common emotional and psychological causes include anger, worry, grief, bipolar disorder, and trauma. Treating these underlying problems is essential to resolving your insomnia.

Medical problems or illness. Many medical conditions and diseases can contribute to insomnia, including asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, and cancer. Chronic pain is also a common cause of insomnia.

Medications. Many prescription drugs can interfere with sleep, including antidepressants, stimulants for ADHD, corticosteroids, thyroid hormone, high blood pressure medications, and some contraceptives. Common over-the-counter culprits include cold and flu medications that contain alcohol, pain relievers that contain caffeine (Midol, Excedrin), diuretics, and slimming pills.

Sleep disorders. Insomnia is itself a sleep disorder, but it can also be a symptom of other sleep disorders, including sleep apnea, restless legs syndrome, and circadian rhythm disturbances tied to jet lag or late-night shift work.

Habits that cause insomnia and disrupt sleep

While treating underlying physical and mental issues is a good first step, it may not be enough to cure your insomnia. You also need to look at your daily habits. Some of the things you’re doing to cope with insomnia may actually be making the problem worse.

For example, maybe you’re using sleeping pills or alcohol to fall asleep, which disrupts sleep even more over the long-term. Or maybe you drink excessive amounts of coffee during the day, making it harder to fall asleep later. Other daytime habits that can negatively impact your ability to sleep at night include having an irregular sleep schedule, napping, eating sugary foods or heavy meals too close to bedtime, and not getting enough exercise or exercising too late in the day.

Not only can poor daytime habits contribute to insomnia, but a poor night’s sleep can make these habits harder to correct, creating a vicious cycle of unrefreshing sleep:

Oftentimes, changing the habits that are reinforcing sleeplessness is enough to overcome the insomnia altogether. It may take a few days for your body to get used to the change, but once you do, you’ll sleep better.

If you’re having trouble identifying insomnia-causing habits

Some habits are so ingrained that you may overlook them as a possible contributor to your insomnia. Maybe your Starbucks habit affects your sleep more than you realize. Or maybe you’ve never made the connection between that late-night glass of wine and your sleep difficulties.

Keeping a sleep diary (or using a sleep tracking app) is a helpful way to pinpoint habits and behaviors contributing to your insomnia.

Treating insomnia with a better sleep environment and routine

Two powerful weapons in the fight against insomnia are a quiet, comfortable bedroom and a relaxing bedtime routine. Both can make a big difference in improving the quality of your sleep.

Make sure your bedroom is quiet, dark, and cool. Noise, light, a bedroom that’s too hot or cold, or an uncomfortable mattress or pillow can all interfere with sleep. Try using a sound machine or earplugs to mask outside noise, an open window or fan to keep the room cool, and blackout curtains or an eye mask to block out light. Experiment with different levels of mattress firmness, foam toppers, and pillows that provide the support you need to sleep comfortably.

Stick to a regular sleep schedule. Support your biological clock by going to bed and getting up at the same time every day, including weekends. Get up at your usual time in the morning even if you’re tired. This will help you get back in a regular sleep rhythm.

Turn off all screens at least an hour before bed. Electronic screens emit a blue light that disrupts your body’s production of melatonin and combats sleepiness. So instead of watching TV or spending time on your phone, tablet, or computer, choose another relaxing activity, such as reading a book or listening to soft music.

Avoid stimulating activity and stressful situations before bedtime. This includes checking messages on social media, big discussions or arguments with your spouse or family, or catching up on work. Postpone these things until the morning.

Avoid naps. Napping during the day can make it more difficult to sleep at night. If you feel like you have to take a nap, limit it to 30 minutes before 3 p.m.

Things to avoid before bed:

Drinking too many liquids. Waking up at night to go to the bathroom becomes a bigger problem as we age. By not drinking anything an hour before sleep and going to the bathroom several times as you get ready for bed, you can reduce the frequency you’ll wake up to go during the night.

Alcohol. While a nightcap may help you to relax and fall asleep, it interferes with your sleep cycle once you’re out, causing you to wake up during the night.

Big evening meals. Try to eat dinner earlier in the evening, and avoid heavy, rich foods within two hours of going to bed. Spicy or acidic foods can cause stomach trouble and heartburn which can wake you during the night.

Caffeine. The American Academy of Sleep Medicine recommends that you stop drinking caffeinated beverages at least six hours before bedtime. People who are sensitive to caffeine may need to stop even earlier.

Insomnia and anxiety

The more trouble you have with sleep, the more it starts to invade your thoughts. You may dread going to sleep because you just know that you’re going to toss and turn for hours or wake up at 2 a.m. again. Or maybe you’re worried because you have a big day tomorrow, and if you don’t get a solid 8 hours, you’re sure you’ll blow it?

Agonizing and expecting sleep difficulties only makes insomnia worse. Worrying about getting to sleep or how tired you’re going to be floods your body with adrenaline, and before you know it, you’re wide-awake.

Relieving anxiety that keeps you from falling or staying asleep

If sleep worries are getting in the way of your ability to unwind at night, the following strategies may help. The goal is to train your body to associate the bed with sleep and nothing else—especially not frustration and anxiety.

Move bedroom clocks out of view. Anxiously watching the minutes tick by when you can’t sleep—knowing that you’re going to be exhausted when the alarm goes off—is a surefire recipe for insomnia. You can use an alarm, but make sure you can’t see the time when you’re in bed.

Get out of bed when you can’t sleep. Don’t try to force yourself to sleep. Tossing and turning only amps up your anxiety. Get up, leave the bedroom, and do something relaxing, such as reading, meditating, or taking a bath. When you’re sleepy, go back to bed.

Challenging the worries and thoughts that fuel insomnia

It’s also helpful to challenge the negative attitudes about sleep and your insomnia problem that you’ve developed over time. The key is to recognize self-defeating thoughts and replace them with more realistic ones.

Remember, learning how to stop worrying takes time and practice. You may find it helpful to jot down your own list, taking note of the negative thoughts that pop up and how you can dispute them. You may be surprised at how often these negative thoughts run through your head. Be patient and ask for support if you need it.

What to do when insomnia wakes you up in the middle of the night

Many people with insomnia are able to fall asleep at bedtime, but then wake up in the middle of the night. They then struggle to get back to sleep, often lying awake for hours. If this describes you, the following tips may help.

Stay out of your head. Hard as it may be, try not to stress over your inability to fall back to sleep, because that stress only encourages your body to stay awake. To stay out of your head, focus on the feelings in your body or practice breathing exercises. Take a breath in, then breathe out slowly while saying or thinking the word, “Ahhh.” Take another breath and repeat.

Make relaxation your goal, not sleep. If you find it hard to fall back to sleep, try a relaxation technique such as visualization, progressive muscle relaxation, or meditation, which can be done without even getting out of bed. Even though it’s not a replacement for sleep, relaxation can still help rejuvenate your mind and body.

Do a quiet, non-stimulating activity. If you’ve been awake for more than 20 minutes, get out of bed and do a quiet, non-stimulating activity, such as reading a book. Keep the lights dim and avoid screens so as not to cue your body that it’s time to wake up.

Postpone worrying and brainstorming. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when it will be easier to resolve. Similarly, if a great idea is keeping you awake, make a note of it on paper and fall back to sleep knowing you’ll be much more productive after a good night’s rest.

Relaxation techniques that can help you get back to sleep

Abdominal breathing. Breathing deeply and fully, involving not only the chest, but also the belly, lower back, and ribcage, can help relaxation. Close your eyes and take deep, slow breaths, making each breath even deeper than the last. Breathe in through your nose and out through your mouth.

Progressive muscle relaxation. Make yourself comfortable. Starting with your feet, tense the muscles as tightly as you can. Hold for a count of 10, and then relax. Continue to do this for every muscle group in your body, working your way up from your feet to the top of your head.

Mindfulness meditation. Sit or lie quietly and focus on your natural breathing and how your body feels in the moment. Allow thoughts and emotions to come and go without judgment, always returning to focus on breath and your body.

Sleep supplements and medication for insomnia

When you’re tossing and turning at night, it can be tempting to turn to sleep aids for relief. But before you do, here’s what you need to know.

Dietary supplements for insomnia

There are many dietary and herbal supplements marketed for their sleep-promoting effects. Although they may be described as “natural,” be aware that sleep remedies can still have side effects and interfere with other medications or vitamins you’re taking. For more information, talk to your doctor or pharmacist.

While scientific evidence is still being gathered for alternative sleep remedies, you might find that some of them work wonderfully for you. The two supplements with the most evidence supporting their effectiveness for insomnia are melatonin and valerian.

Prescription sleeping pills

While prescription sleep medications can provide temporary relief, it’s important to understand that sleeping pills are not a cure for insomnia. And if not used carefully, they actually make insomnia worse in the long run. It’s best to use medication only as a last resort, and then, only on a very limited, as-needed basis.

First, try changing your sleep habits, your daily routine, and your attitudes about sleep. Evidence shows that lifestyle and behavioral changes make the largest and most lasting difference when it comes to insomnia.

When to see a doctor about insomnia

If you’ve tried a variety of self-help techniques without success, schedule an appointment with a sleep specialist, especially if insomnia is taking a heavy toll on your mood and health. Provide the doctor with as much supporting information as possible, including information from your sleep diary.

Therapy vs. sleeping pills for insomnia

In general, sleeping pills and sleep aids are most effective when used sparingly for short-term situations, such as traveling across time zones or recovering from a medical procedure. Your insomnia won’t be cured by sleeping pills—in fact, over the long-term they can actually make insomnia worse.

Since many people complain that frustrating, negative thoughts and worries prevent them from sleeping at night, cognitive-behavioral therapy (CBT) can be much more effective in addressing insomnia. CBT is a form of psychotherapy that treats problems by modifying negative thoughts, emotions, and patterns of behavior. It can be conducted individually, in a group, or even online. A study at Harvard Medical School found that CBT was more effective at treating chronic insomnia than prescription sleep medication—but without the risks or side effects.

What To Do When You Can’t Sleep

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If you’re one of the millions of Americans who struggle with insomnia, you may find your mind racing and your body tossing and turning when you just want to be asleep.

With the right approach, you can reliably fall asleep within a matter of minutes. One of the keys to smoothly falling asleep is relaxation. Research shows that the relaxation response is a physiological process that positively affects both the mind and body.

By reducing stress and anxiety, the relaxation response can enable you to peacefully drift off to sleep. Our step-by-step guides offer proven relaxation methods that may help with insomnia and other sleep problems.

Experts emphasize that it can take time to master these techniques, but the practice pays off. Even better, these methods are customizable, so you can adjust them over time to make them work for you.

The Four Key Elements to Cultivating Relaxation

For thousands of years, relaxation has been a central focus of spiritual and cultural practices, enabling a sense of calm and connection with oneself and the surrounding world.

Only in recent decades, though, have meditative practices for relaxation become a focus of scientific research, which has come to identify four key elements for fostering the relaxation response.

All of the following methods are ways of achieving these core elements so that you can calmly fall asleep. Keeping these basics in mind empowers you to adjust these methods to suit your preferences.

Falling Asleep With Relaxation Techniques

Once you’re lying comfortably in bed, try one of these techniques to put yourself at ease and settle gently into sleep.

Controlled Breathing

A series of slow, deep breaths can enable a sense of calm. This method, also known as pranayamic breathing, is believed to help reduce stress in the nervous system and may prepare the brain for sleep by reducing excitatory stimulus.

Option 1: Counting Breaths

Option 2: Dr. Andrew Weil’s 4-7-8 Method

Who It’s Great For:

Controlled breathing is excellent for people just getting started with relaxation techniques or who have difficulty using other objects of focus like imagery or mantras.

Meditation and Mindfulness

Mindfulness is centered around slow, steady breathing and a non-judgmental focus on the present moment. By reducing anxiety and rumination, it has been found to have sweeping health benefits, including an ability to help reduce insomnia.

There are many variations of mindfulness meditation for different situations. One easy to use style is the body scan meditation.

This version is adapted from UC-Berkeley’s Greater Good in Action (GGIA) program that offers audio recordings for this and other mindfulness meditations.

Who It’s Great For:

Anyone can meditate, including with mindfulness meditation, but it can take more practice to get used to. As a result, it usually works best for people who can devote at least five minutes per day to increase their comfort with it.

Progressive Muscle Relaxation

Progressive muscle relaxation (PMR) creates a calming effect by gradually tightening and releasing muscles throughout the body in conjunction with controlled breathing.

Who it’s Great For:

Studies have found that PMR can help people with insomnia, and when done carefully, may be beneficial for people who are bothered by arthritis or other forms of physical pain. PMR is not recommended for people with uncontrolled cardiovascular problems.

Imagery

Visualizing a peaceful image from your past and all of its details engages your attention in order to promote relaxation.

Who it’s Great For:

Visual thinkers who easily recall past scenes replete with details are ideally suited to using imagery as part of their bedtime relaxation.

Are There Downsides to Relaxation Techniques?

Negative consequences are rare for relaxation techniques, but a small number of people find that they can provoke anxiety. Anyone with concerns about trying these methods should talk with their doctor for specific advice before getting started.

What to Do About Mind Wandering

Even experts in meditation find that their minds can wander during these relaxation techniques, so don’t worry if it happens to you. Instead, stay calm, keep breathing slowly, and try to bring your mind back to the main focus of attention.

What If I Still Can’t Fall Asleep?

If you get into bed and cannot fall asleep after 20 minutes, get up, go to another part of your house, and do something soothing, such as reading or listening to quiet music.

Lying awake in bed for too long can create an unhealthy mental connection between your sleeping environment and wakefulness. Instead, you want your bed to conjure thoughts and feelings conducive to sleep.

Pre-Bedtime Tips to Help Fall Asleep Quickly

Before you actually get into bed, a few simple tips can help make sure your mind and body are prepared to fall asleep easily:

Big-Picture Tips to Fall Asleep Easily

Beyond the immediate run-up to bedtime, incorporating fundamental sleep tips can aid in falling asleep and prevent serious sleeping problems.

About Our Editorial Team

Eric Suni

Eric Suni has over a decade of experience as a science writer and was previously an information specialist for the National Cancer Institute.

Dr. Abhinav Singh

Dr. Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the entire myriad of sleep disorders.

What to Do When You Can’t Sleep: All About Insomnia Treatments

Counting sheep not doing the trick? Here’s a look at the different options that could help you finally get some shut-eye.

You lie awake at night staring at the ceiling. You feel like you’re cursed, but you’re not alone. Estimates suggest between 1 in 10 and 1 in 3 people suffer from some degree of insomnia, which is having trouble with either falling asleep, staying asleep during the night, or waking up earlier than you intend to in the morning (or a combination of the above). (1 )

There are many reasons why you might be struggling to fall asleep or stay asleep throughout the night, ranging from stressful life events, like getting fired from a job, to health issues. (2 ) What’s more, those periods of short-term insomnia that last just a few days or a week (acute insomnia), can turn into longer-term insomnia, which is known as chronic insomnia, meaning that your sleep troubles last beyond the initial stressor.

Here are some of the treatment options your doctor or a sleep specialist might recommend if you have insomnia.

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And if you’re doing all that and still have trouble sleeping, keep a few tips in mind, such as don’t lie in bed for hours if you can’t sleep. “If it’s been 20 minutes and you’re frustrated you’re not asleep and you’re thinking, ‘Why am I not asleep yet?’ or ‘I need to do this, this, and this tomorrow’ — that’s counterproductive,” Aouad says.

You can start to work yourself up and associate the bed with not sleeping, making it tougher to fall asleep like you want to do. “Leave the bedroom and do something boring,” she says, such as washing the dishes or folding laundry until you start to feel tired.

Or, if it’s an anxious mind that’s keeping you up, try scheduling worry time for tomorrow. “The worries tend to come out at night when there are fewer distractions and you’re not busy with tasks,” Aouad says. By writing the worries down on paper and setting aside time to address them the following day, you’re more likely to be able to let them go and get some rest. “The goal is to control your worries and not have your worries control you,” Aouad says.

Cognitive Behavioral Therapy Is the Gold-Standard for Treating Chronic Insomnia

If improving sleep hygiene and other lifestyle changes alone don’t help with your sleep, the next step is cognitive behavioral therapy to improve sleep and reverse chronic insomnia. Aouad says it’s a better option than medication.

“Medication will help you as long as it’s in your system, so that’s a day or two,” she says. While there are some appropriate uses for prescription sleep aids (if they are used correctly), they can come with extremely dangerous side effects, and they tend to be highly addictive. (3) “The benefits of cognitive behavioral therapy, a specific type of counseling to help with the anxiety around sleep that comes with chronic insomnia, have been shown to far outlast medication,” Aouad explains.

According to a study published in May 2012 in the journal BMC Family Practice, cognitive behavioral therapy is better at improving sleep efficiency than common drugs, and led to an extra 30 to 60 minutes in sleep time when the two treatment strategies were compared. (4)

Cognitive behavioral therapy focuses on teaching techniques to help you relax, control your breathing and mood, slow down your racing mind, and get to sleep. “Really, the basis of it is providing education, talking about sleep drive and teaching people things like stimulus control and avoiding anything stimulating around bedtime,” Aouad says. Think of it as reteaching your body how to sleep.

The therapy also involves sleep restriction. (5) “Some people have this misunderstanding that if I can’t sleep, then I should spend more time in bed to try to get myself to sleep,” Aouad says. “Actually you should really only be in bed for the time that you’re sleeping.” The idea is by cutting down on the amount of time you spend lying in bed awake, you’ll be more tired and more likely to fall asleep quickly next time.

A study published in June 2015 in the journal Sleep found just one session of cognitive behavioral therapy plus a self-help pamphlet effectively treated about half of the cases of acute insomnia. (6)

Aouad suggests seeking a therapist who has experience providing cognitive behavioral therapy for insomnia — the American Board of Sleep Medicine has a helpful list published on its website. (7) Usually it’s offered as a series of in-person sessions over the course of four to six weeks, though there are some online programs that could be helpful for people living in remote areas or for those without insurance, Aouad says.

Prescription and OTC Sleep Aids Can Help, But They Are Meant to Be Short-Term Solutions

Before turning to medication, your doctor should rule out other possible health issues. Insomnia oftentimes is a side effect of an underlying issue, such as depression or an anxiety disorder, in which case an antidepressant could be more beneficial than a sleep aid. If there’s something else going on, that issue should be addressed versus putting a Band-Aid on the problem with sleep medication, Aouad says.

“If you try sleep hygiene and cognitive behavioral therapy for insomnia, and you’re not seeing the benefit, I would say see a specialist so they can rule out any other possible medical or mental health issues that could be contributing to the insomnia and help direct you to treatment,” Aouad says.

In these cases, over-the-counter or prescription sleep medication can be helpful if used for a short period of time, as you simultaneously establish a healthier sleep routine — by improving your sleep hygiene and forming habits that allow you to get the sleep you need. The ideal scenario is that you once you do get into a better sleep routine, you can stop taking the medication, but continue to sleep well.

If medication is prescribed, take it for as little time as necessary since it can be habit forming, Aouad says — three months at maximum. And be sure to discuss the medication’s purpose and side effects with your doctor.

For example, some medicines may help you fall asleep but leave you dealing with grogginess in the morning. Others can cause complications, such as sleep walking or sleep driving. And some drugs have been found to increase mortality risk, regardless of pre-existing conditions, according to a study published in February 2012 in the journal BMJ Open. (8 ) Your doctor should also discuss any previous, existing, or potential mental health problems with you before prescribing a sleep aid, as some can heighten risk of depression and suicide, noted a study published in January 2017 in the American Journal of Psychiatry. (9 )

Types of prescription sleep aids include:

Melatonin, a supplement that promotes sleep, can also be helpful, though it’s better at treating circadian rhythm issues (such as jetlag) than insomnia. (10) It’s not meant for nightly use, but Aouad says it’s worth a try in the short term because it’s sold over the counter and is generally harmless.

«The recommended dose is the smallest dose that’s effective to help you sleep,» she says. «I would say 10 milligrams (mg) is the max, but most people should use 1 to 3 mg.» She says to take it about an hour before bed and recommends consulting your doctor first if you’re pregnant, breast-feeding, or plan to become pregnant.

Ideally, you’d take the supplement for about four or five days to get your circadian rhythm realigned to your new bedtime, but if you’ve been taking it for a month and still having trouble, it’s time to visit a doctor. At this point, it’s not about being prescribed a stronger medication as much as it’s about figuring out the underlying issue, Aouad says.